U.S. GOVERNMENT ACCOUNTABILITY OFFRICE REPORT ON PSYCHOTROPICS FOR KIDS IN CARE
http://www.gao.gov/new.items/d12270t.pdf
Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions
GAO-12-270T December 1, 2011
Summary
Foster children have often been removed from abusive or neglectful homes and tend to have more mental health conditions than other children. Treatment may include psychotropic drugs but their risks to children are not well understood. Medicaid, administered by states and overseen by the Department of Health and Human Services (HHS), provides prescription drug coverage to foster children.
This testimony examines (1) rates of psychotropic prescriptions for foster and nonfoster children in 2008 and (2) state oversight of psychotropic prescriptions for foster children through October 2011. GAO selected Florida, Maryland, Massachusetts, Michigan, Oregon, and Texas primarily based on their geographic diversity and size of the foster care population.
Results cannot be generalized to other states. In addition, GAO analyzed Medicaid fee-for-service and foster care data from selected states for 2008, the most recent year of prescription data available at the start of the audit. Maryland's 2008 foster care data was unreliable. GAO also used expert child psychiatrists to provide a clinical perspective on its methodology and analysis, reviewed regulations and state policies, and interviewed federal and state officials.
Foster children in the five states GAO analyzed were prescribed psychotropic drugs at higher rates than nonfoster children in Medicaid during 2008, which according to research, experts consulted, and certain federal and state officials, could be due in part to foster children's greater mental health needs, greater exposure to traumatic experiences and the challenges of coordinating their medical care. However, prescriptions to foster children in these states were also more likely to have indicators of potential health risks. According to GAO's experts, no evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and nonfoster children in the five states had such a drug regimen. Similarly, thousands of foster and nonfoster children were prescribed doses higher than the maximum levels cited in guidelines developed by Texas based on FDA-approved labels, which GAO's experts said increases the risk of adverse side effects and does not typically increase the efficacy of the drugs to any significant extent. Further, foster and nonfoster children under 1 year old were prescribed psychotropic drugs, which GAO's experts said have no established use for mental health conditions in infants; providing them these drugs could result in serious adverse effects. Selected states' monitoring programs for psychotropic drugs provided to foster children fall short of best principle guidelines published by the American Academy of Child and Adolescent Psychiatry (AACAP).
The guidelines, which states are not required to follow, cover four categories. (1) Consent: Each state has some practices consistent with AACAP consent guidelines, such as identifying caregivers empowered to give consent. (2) Oversight: Each state has procedures consistent with some but not all oversight guidelines, which include monitoring rates of prescriptions. (3) Consultation: Five states have implemented some but not all guidelines, which include providing consultations by child psychiatrists by request. (4) Information: Four states have created websites about psychotropic drugs for clinicians, foster parents, and other caregivers. This variation is expected because states set their own guidelines. HHS has not endorsed specific measures for state oversight of psychotropic prescriptions for foster children. HHS-endorsed guidance could help close gaps in oversight of psychotropic prescriptions and increase protections for these vulnerable children. In our draft report, GAO recommended that HHS consider endorsing guidance for states on best practices for overseeing psychotropic prescriptions for foster children. HHS agreed with our recommendation. Agency comments will be incorporated and addressed in a written report that will be issued in December 2011.
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| FOSTER CHILDREN AFFECTED BY BIG PHARMA CORRUPTION |
FOSTER CHILDREN
HHS Guidance Could Help
States Improve Oversight of
Psychotropic Prescriptions
Statement of Gregory D. Kutz, Director
Forensic Audits and Investigative Service
Testimony
Before the Subcommittee on Federal Financial Management,
Government Information, Federal Services, and
International Security, Committee on Homeland Security
and Governmental Affairs, U.S. Senate
For Release on Delivery
Expected at 10:30 a.m. EST
Thursday, December 1, 2011
GAO-12-270T
United States Government Accountability Office
Highlights of GAO-12-270T, a testimony
before the Subcommittee on Federal Financial
Management, Government Information,
Federal Services, and International Security;
Committee on Homeland Security and
Governmental Affairs; U.S. Senate
December 2011
FOSTER CHILDREN
HHS Guidance Could Help States Improve Oversight
of Psychotropic Prescriptions
Why GAO Did This Study
Foster children have often been
removed from abusive or neglectful
homes and tend to have more mental
health conditions than other children.
Treatment may include psychotropic
drugs but their risks to children are not
well understood. Medicaid,
administered by states and overseen
by the Department of Health and
Human Services (HHS), provides
prescription drug coverage to foster
children.
This testimony examines (1) rates of
psychotropic prescriptions for foster
and nonfoster children in 2008 and (2)
state oversight of psychotropic
prescriptions for foster children through
October 2011. GAO selected Florida,
Maryland, Massachusetts, Michigan,
Oregon, and Texas primarily based on
their geographic diversity and size of
the foster care population. Results
cannot be generalized to other states.
In addition, GAO analyzed Medicaid
fee-for-service and foster care data
from selected states for 2008, the most
recent year of prescription data
available at the start of the audit.
Maryland’s 2008 foster care data was
unreliable. GAO also used expert child
psychiatrists to provide a clinical
perspective on its methodology and
analysis, reviewed regulations and
state policies, and interviewed federal
and state officials.
What GAO Recommends
In our draft report, GAO recommended
that HHS consider endorsing guidance
for states on best practices for
overseeing psychotropic prescriptions
for foster children. HHS agreed with
our recommendation. Agency
comments will be incorporated and
addressed in a written report that will
be issued in December 2011.
What GAO Found
Foster children in the five states GAO analyzed were prescribed psychotropic drugs at higher rates than nonfoster children in Medicaid during 2008, which according to research, experts consulted, and certain federal and state officials,could be due in part to foster children’s greater mental health needs, greater
exposure to traumatic experiences and the challenges of coordinating their medical care. However, prescriptions to foster children in these states were also more likely to have indicators of potential health risks. According to GAO’s
experts, no evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and nonfoster children in the five states had such a drug regimen. Similarly, thousands of foster and nonfoster children were prescribed doses higher than the maximum levels cited in guidelines developed by Texas based on FDA-approved labels, which GAO’s experts said increases the risk of adverse side effects and does not typically increase the efficacy of the drugs to any significant extent. Further, foster and nonfoster children under 1 year old were prescribed psychotropic drugs, which GAO’s experts said have no established use for mental health conditions in infants; providing them these drugs could result in serious adverse effects.
Psychotropic Prescription Rates for Foster and Nonfoster Children Age 0-17 in Medicaid.
IN ALL AREAS THE RATES FOR CHILDREN IN CARE WERE SIGNIFICANTLY HIGHER
Source: GAO analysis of state Medicaid and foster care data.
% of foster children
Prescribed at least one
psychotropic medication:
% of nonfoster children
Selected states’ monitoring programs for psychotropic drugs provided to foster
children fall short of best principle guidelines published by the American
Academy of Child and Adolescent Psychiatry (AACAP). The guidelines, which
states are not required to follow, cover four categories.
• Consent: Each state has some practices consistent with AACAP consent
guidelines, such as identifying caregivers empowered to give consent.
• Oversight: Each state has procedures consistent with some but not all
oversight guidelines, which include monitoring rates of prescriptions.
• Consultation: Five states have implemented some but not all guidelines,
which include providing consultations by child psychiatrists by request.
• Information: Four states have created websites about psychotropic drugs for
clinicians, foster parents, and other caregivers.
This variation is expected because states set their own guidelines. HHS has not
endorsed specific measures for state oversight of psychotropic prescriptions for
foster children. HHS-endorsed guidance could help close gaps in oversight of
psychotropic prescriptions and increase protections for these vulnerable children.
View GAO-12-270T or key components. For
more information, contact Gregory D. Kutz at
(202) 512-6722 or kutzg@gao.gov.
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